Color-coded Wristband Standardization in Louisiana

1. Color-coded WristbandStandardization in Louisiana “Banding Together for Patient Safety”

2. Color-coded WristbandStandardization in LouisianaExecutive Summary Background: • In Pennsylvania there was confusion regarding wristband color that resulted in a patient being labeled DNR erroneously • In 2008, the American Hospital Association (AHA) issued a quality advisory recommending that hospitals consider using certain standardized colors for alert wristbands “Banding Together for Patient Safety”

3. Color-coded WristbandStandardization in Louisiana Executive Summary • In 2008, the LHA Quality and Patient Safety Advisory Panel recommended to the LHA Board of Trustees that the three standard colors (red for patient allergies, yellow for a fall risk; and purple for do-not-resuscitate patient preferences) recommended by the AHA be used to standardize the color code alert wristbands in Louisiana. They also recommended that hospitals adopt green for latex allergy and pink for restricted extremity. “Banding Together for Patient Safety”

4. Color-coded WristbandStandardization in Louisiana Executive Summary • The choice of color to designate certain conditions is not limited to wristbands. The LHA Quality and Patient Safety Advisory Panel recommended that any form of designation that is used for the five conditions be consistent with the colors of the wristbands. For example, if labels or clasps are used in lieu of a wristband to alert clinicians of a certain medical condition, then the labels and clasps should be consistent with the color that should be used for the alert wristband. “Banding Together for Patient Safety”

5. Color-coded WristbandStandardization in LouisianaExecutive Summary What about staff impact? • New staff – Louisiana hospitals reported an RN vacancy rate average of approximately 18 nursing vacancies per hospital (2008) • Approximately 50% of current vacancies have resulted from turnover • Many hospitals in the state are using agency and traveler RNs to staff vacant positions “Banding Together for Patient Safety”

6. Color-coded WristbandStandardization in Louisiana Executive Summary What did we conclude? • Potential for confusion exists • Opportunity to reduce potential for harm and improve patient safety “Banding Together for Patient Safety”

7. Color-coded WristbandStandardization in Louisiana Executive Summary What did we do? • LHA reviewed the growing national trend to adopt a standardized wristband color program • In December 2008, the LHA Board of Trustees adopted a statewide policy supporting the adoption of the three standardized colors and the additional two colors for latex allergy and restricted extremity • Hospitals should have a program in place by June 1, 2009 “Banding Together for Patient Safety”

8. Color-coded WristbandStandardization in Louisiana Executive Summary The Tool Kit contents include: • The colors for the alert designation • The logic for the colors selected • A work plan for implementation • Staff education including competencies “Banding Together for Patient Safety”

9. Color-coded WristbandStandardization in Louisiana Executive Summary The Tool Kit contents include (cont.): 5. FAQs for general distribution 6. Sample policy and procedure 7. Vendor information for easy adoption 8. Patient education brochure “Banding Together for Patient Safety”

10. Color-coded WristbandStandardization in LouisianaExecutive Summary Our safety as a state and success in this effort will depend on the participation and adoption of each and every hospital in Louisiana. “Banding Together for Patient Safety”

11. Color-coded WristbandStandardization in Louisiana “Banding Together for Patient Safety”

12. Color-coded WristbandStandardization in LouisianaDo Not Resuscitate Recommendation: DNR - Purple It is recommended that hospitals adopt the color PURPLE for the Do Not Resuscitate designation with the words embossed / printed on the wristband, label or clasp, “DNR.” Calling CODE BLUE! • Recommended in the Standardized Hospital Emergency Code for the State of Louisiana • If Louisiana selected the color blue for the DNR wristband, the potential for confusion exists. • “Does blue mean I code or I do not code?” “Banding Together for Patient Safety”

13. Color-coded WristbandStandardization in LouisianaDo Not Resuscitate Recommendation - PURPLE for Do Not Resuscitate • Why not blue? • Should not be the same color that is used for calling a code • Registry, turnover, travelers, etc • Why not green? • “Go ahead” confusion • If we adopt purple, do we still need to look in the chart? • Yes! • Code designation can and does change during a patients stay “Banding Together for Patient Safety”

14. Color-coded WristbandStandardization in LouisianaAllergy Quick Adoption By adopting red for allergy alert, the standardization for this is easily achieved since a number of Louisiana hospitals already use red for allergy alert. Recommendation: Allergy - Red It is recommended that hospitals adopt the color RED for the ALLERGY ALERT designation with the words embossed / printed on the wristband, label or clasp, “ALLERGY.” Allergies “Banding Together for Patient Safety”

15. Color-coded WristbandStandardization in Louisiana Allergy Recommendation - RED for the Allergy Alert • Why Red? • Many hospitals in Louisiana currently use red • Any other reasons? • Associated with other messages such as STOP! DANGER! due to traffic lights and ambulance/police lights • Do we write the allergies on the wristband too? • No because that may create new errors due to: • Legibility issues • Allergy list may change • Patient chart should be the source for the specifics “Banding Together for Patient Safety”

16. Color-coded WristbandStandardization in Louisiana Fall Risk Allergies Recommendation: Fall - Yellow It is recommended that hospitals adopt the color YELLOW for the Fall Risk Alert designation with the words embossed / written on the wristband, label or clasp, “Fall Risk.” Falls account for more than 70 percent of the total injury-related health cost among people 60 years of age and older. “Banding Together for Patient Safety”

17. Color-coded WristbandStandardization in LouisianaFall Risk Allergies Recommendation - YELLOW for Fall Risk • Why Yellow? • Associated with “Caution” or “Slow Down” (Stop Lights and School Buses) • American National Standards Institute (ANSI) • All health care providers want to be alert to fall risks as they can be prevented by anyone “Banding Together for Patient Safety”

18. Color-coded WristbandStandardization in LouisianaRestricted Extremity • Recommendation - Pinkfor Restricted Extremity • It is recommended that hospitals adopt the color of Pink for the Restricted Extremity Alert designation with the words embossed / written on the wristband or clasp, “Restricted Extremity.” “Banding Together for Patient Safety”

19. Color-coded WristbandStandardization in LouisianaRestricted Extremity Recommendation - Pinkfor Restricted Extremity • Why Pink? When a patient has this color-coded wristband, it is alerting the health provider that the patient’s extremity should be handled with extreme care. This alerts providers to check with the nurse prior to any tests or procedures. • Why even use an alert for Restricted Extremity? The pink wristband has been used for breast cancer/lymphedema patients to indicate the extremity should not be used for starting an intravenous line or drawing laboratory specimens. Circulation is compromised in a patient with lymphedema and unnecessary invasive procedures should be avoided in the affected extremity. Pink wristbands can be used to indicate any other diagnosis that results in a restricted extremity. “Banding Together for Patient Safety”

20. Color-coded WristbandStandardization in LouisianaLatex Allergy Recommendation - Green for Latex Allergy It is recommended that hospitals adopt the color of GREEN for the latex allergy alert designation with the words embossed/written on the wristband or clasp, “Latex Allergy.” “Banding Together for Patient Safety”

21. Color-coded WristbandStandardization in LouisianaLatex Allergy Recommendation - Green for Latex Allergy • Why Green? When a patient has this color-coded wristband, it indicates an allergic reaction to latex. This green wristband will alert the doctors, nurses, and other health care professionals about latex allergies.   “Banding Together for Patient Safety”

22. Color-coded WristbandStandardization in Louisiana “Banding Together for Patient Safety”

23. Color-coded WristbandStandardization in LouisianaWork Plan Documents A Suggested Work Plan for Facility Preparation, Staff Education, and Patient Education that includes: • Organizational Approval • Supplies Assessment and Purchase • Hospital Specific Documentation • Staff and Patient Education Materials and Training Following the Work Plan is a Task Chart for each plan that provides cues for methodical and successful implementation. “Banding Together for Patient Safety”

24. Color-coded WristbandStandardization in LouisianaSample Work Plan Document “Banding Together for Patient Safety”

25. Color-coded WristbandStandardization in LouisianaSample Task Chart “Banding Together for Patient Safety”

26. Color-coded WristbandStandardization in Louisiana “Banding Together for Patient Safety”

27. Color-coded WristbandStandardization in LouisianaStaff Education Tools for Staff Education: • Poster announcing the training meeting dates/times • Staff Sign-In Sheet • Staff competency check list • Tri-fold Staff education brochure about this initiative • FAQs hand out for staff • Tri-fold Patient education brochure about color-coded wristbands • PowerPoint presentation “Banding Together for Patient Safety”

28. Color-coded WristbandStandardization in Louisiana Staff Education Tri-fold Staff education brochure that includes: • How this all got started…The Pennsylvania story • Why we need to do this in Louisiana • The National Picture • What the colors are for Allergy, Fall Risk, DNR, Latex Allergy and Restricted Extremity • Script for any staff person talking to a patient or family about the wristbands • “Quick Reference Card” cut out that lists 7 other risk reduction strategies  “Banding Together for Patient Safety”

29. Color-coded WristbandStandardization in LouisianaStaff Education Color-coded “Alert” Wristbands / Risk Reduction Strategies A Quick Reference Card ==================================== • Use wristbands with the alert message pre-printed (such as “DNR”) • Remove any “social cause” colored wristbands (such as “Live Strong”) • Remove wristbands that have been applied from another facility “Banding Together for Patient Safety”

30. Color-coded WristbandStandardization in LouisianaStaff Education Color-coded “Alert” Wristbands / Risk Reduction Strategies A Quick Reference Card =================================== 4. Initiate banding upon admission, changes in condition, or when information is received during hospital stay 5. Educate patients and family members regarding the wristbands 6. Coordinate chart/white board/care plan/door signage information/stickers with same color coding 7. Educate staff to verify patient color-coded “alert” arm bands upon assessment, hand-off of care and facility transfer communication “Banding Together for Patient Safety”

31. Color-coded WristbandStandardization in LouisianaStaff Education • Why have a Script for Staff? • We know how we say something is as important as what we say. This provides a script sheet so staff can work on the “how” as well as the “what.” • Serves as an aid to help staff be comfortable when discussing the topic of a DNR wristband. • Promotes patient / family involvement and reminds the patient/family to alert staff is information is not correct. • By following a script, patients and families receive consistent message – which helps with retention of the information. • Patient Education brochure also available for staff to hand out. “Banding Together for Patient Safety”

32. Color-coded WristbandStandardization in LouisianaStaff Education SCRIPT for any staff person talking to a patient or family What is a Color-coded “Alert” Wristband? Color-coded alert wristbands are used in hospitals to quickly communicate a certain health care status, condition, or an “alert” that a patient may have. This is done so every staff member can provide the best care possible. What do the colors mean? There are five different color-coded “alert” wristbands that we are going to discuss because they are the most commonly ones used. ~ continued on next slide~ “Banding Together for Patient Safety”

33. Color-coded WristbandStandardization in LouisianaStaff Education SCRIPT for any staff person talking to a patient or family RED means ALLERGY ALERT If a patient has an allergy to anything - food, medicine, dust, grass, pet hair, ANYTHING- tell us. It may not seem important to you but it could be very important in the care the patient receives. YELLOW means FALL RISK We want to prevent falls at all times. Nurses assess patients all the time to determine if they need extra attention in order to prevent a fall. Sometimes, a person may become weakened during their illness or because they just had a surgery. When a patient has this color-coded alert wristband, the nurse is indicating this person needs to be closely monitored because they could fall. ~ continued on next slide~ “Banding Together for Patient Safety”

34. Color-coded WristbandStandardization in LouisianaStaff Education SCRIPT for any staff person talking to a patient or family PURPLE means “DNR” Or Do Not Resuscitate Some patients have expressed an end-of-life wish and we want to honor that. GREEN means Latex Allergy The nurse is indicating that the patient has or may have an allergy to latex and latex products which could case anaphylsis, a potentially life-threatening condition. PINK means Restricted Extremity The nurse is indicating the patient’s extremity should be handled with care; other care providers are alerted to check with the nurse prior to any tests or procedures. “Banding Together for Patient Safety”

35. Color-coded WristbandStandardization in Louisiana “Banding Together for Patient Safety”

36. Color-coded WristbandStandardization in LouisianaPolicy and Procedures • A template Policy and Procedures has been provided. • Make modifications to it so it fits your organization’s process and culture. • Includes a “Patient Refusal to Participate in the Wristband Process” process. “Banding Together for Patient Safety”

37. Color-coded WristbandStandardization in LouisianaExcerpt from Refusal Form The above named patient refuses to: (check what applies) □ Wear color-coded alert wristbands. The benefits of the use of color-coded wristbands have been explained to me by a member of the health care team. I understand the risk and benefits of the use of color-coded wristbands, and despite this information, I do not give permission for the use of color-coded wristbands in my care. □ Remove “Social Cause” colored wristbands (like “Live Strong” and others). The risks of refusing to remove the “Social Cause” colored wristbands have been explained to me by a member of the health care team. I understand that by refusing to remove the “Social Cause” wristbands could cause confusion in my care, and despite this information, I do not give permission for the removal of the “Social Cause” colored wristbands. Reason provided (if any): ___________________________________________________ _____________ ________________________________________________ Date / Time Signature / Relationship _____________ ________________________________________________ Date / Time Witness Signature / Job Title “Banding Together for Patient Safety”

38. Color-coded WristbandStandardization in Louisiana National Efforts “Banding Together for Patient Safety”

39. Color-coded WristbandStandardization in LouisianaNational Efforts “Banding Together for Patient Safety”

40. Color-coded WristbandStandardization in LouisianaResources Questions? Contact Kenneth E. Alexander Louisiana Hospital Association Phone number: (225)928-0026 Email: kalexander@lhaonline.org To access an online version of this Tool Kit go to the patient safety page of the LHA website at: http://www.lhaonline.org/displaycommon.cfm?an=1&subarticlenbr=424 “Banding Together for Patient Safety”